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Metric Driven Strategy for EHR Continuous Improvement
Session #36, February 12, 2019
Brian Kay, Vice President Continuous Improvement
Nicole Klaus, Director EHR Optimization and Strategy
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Brian Kay, MS
Has no real or apparent conflicts of interest to report.
Nicole Klaus, RN, MBA, MPA
Has no real or apparent conflicts of interest to report.
Conflict of Interest
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• Learning Objectives
• About Us
• Rogers Improvement System
• Managing for Daily Improvement
• Application of Agile Methods
• Lessons Learned
Agenda
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• Identify the strategic benefits of employing daily
and monthly review of EHR performance metrics
in project identification
• Evaluate the challenges and opportunities to
overcome them when using data to make
decisions on continuous improvement objectives
• Select metrics that align with the organization’s
vision and strategy
Learning Objectives
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Rogers Behavioral Health:
About Rogers – Who We Are
• Established in 1907 as Rogers Memorial Hospital,
Wisconsin’s largest private, unaffiliated, not-for-profit
psychiatric and addiction services hospital.
• Psychiatrist-driven, evidence-based models of care
by multidisciplinary teams that also include general
medicine physicians, psychologists and other
psychiatric clinicians.
• Robust service continuum for the right intensity of
care at the right time:
– Inpatient hospitalization
– Residential treatment centers
– Partial hospitalization (PHP)
– Intensive outpatient (IOP)
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Six Rogers Memorial Hospital Wisconsin
locations:
– Oconomowoc
• Inpatient hospital
• 8 residential
centers
• PHP and IOPs
– West Allis
• Inpatient hospital
• PHPs and IOPs
– Brown Deer
• Inpatient hospital
• PHPs and IOPs
– Madison
• PHPs and IOPs
– Kenosha
• PHPs and IOPs
– Appleton
• PHPs and IOPs
Rogers Behavioral Health:
About Rogers – Who We Are
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Regional Rogers Behavioral Health network of specialty clinics
(PHPs and IOPs):
• Tampa Bay
• Nashville
• Chicago
• Minneapolis
• Philadelphia
• St. Paul
• San Francisco Bay Area
• Miami
• San Diego
Rogers Behavioral Health:
About Rogers – Who We Are
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• Intensive, multimodal treatment in structured
therapeutic settings under supervision of board-
certified psychiatrists.
– On-site access to experts in psychiatric
subspecialties and psychology for additional clinical
consultation.
• Individualized treatment plans, flexed to
accommodate typical and atypical
fluctuations/shifts in response and comorbidities.
• Length of stay calibrated to achieve optimal
therapeutic impact and to sustain and build upon
treatment gains post discharge.
Rogers Behavioral Health:
About Rogers – What We Do
Specialized continuums of care:
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Intake
Employee
Experience
Depression
Practice
Management
VSST
EST
TPOC
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Managing for Daily Improvement (MDI) is
focused on transforming to a leadership
culture that:
• Creates, accommodates, and sustains a
culture of continuous improvement.
• Facilitates a data driven, action oriented,
engaged & empowered lean organization.
• Are we having a ‘good’ or ‘bad’ day?
• What would ‘better’ not ‘perfection’ look like?
• If you have an idea for ‘better’, how would you
implement it? How would sustain it? How
would you improve it?
MDI is about People
What is MDI?
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What is MDI
• A series of repeatable processes
designed to…
– Connect everyone to what is important
– Help leaders at all levels spot normal
from abnormal conditions
– Identify and proactively address issues
that impede our success
– Develop leaders as coaches
– Resolve our “gaps” through team-driven
problem solving and A3’s
– Sustain breakthroughs from team
improvements
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Standardized Work - Method
The best known way TODAY
Standard Work will
Sustain the gains
A3 Thinking (PDCA) drives
Continuous Improvement
STD WORK
Performance
Time
STD WORK
Performance
Time
Standard Work is intended to drive change. The more
frequent the change the faster the improvement.
Continually Higher
Performance is an
indication of a healthy
organization
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Tier 1 Readiness Huddle
• Key Features:
– Safety issues are proactively addressed (focus on preventing harm)
– Check Methods, Equipment, Supplies, and Staff’s (MESS) readiness for the day’s work
– Understand the day’s work plan / schedule (volume, special needs for patients, etc)
• Leader Standard Work:
– Front-line leader performs SMESS checks
– Leaders perform tiered huddles (unit level to one up) to escalate issues
– Higher-level leaders confirm / coach / support performance of these tasks
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• Follow standard work
• Escalate if SW cannot be
followed
• Check MESS
• Run Tier 1 huddle
• Track and maintain area
performance
• Respond to andon and track
abnormalities
• Confirm standard work
• Do daily PDCA
• Run Tier 2 huddle & plan for the day
• Monitor unit performance
• Perform gemba rounds
• Confirm & coach team leads & supv’s
on LSW
• Resolve escalated problems
• Perform root cause problem solving
• Perform gemba rounds and walks
• Perform check-act on weekly/monthly
performance
• Coach managers on LSW
• Lead cross-department problem solving
• Ensure that DMS is followed and
improved
• Perform gemba walks
• Ensure that big issues are resolved
• Model coaching and problem solving
• Perform gemba walks
• Engage leaders in achieving goals
• Model coaching and problem solving
• Understand and develop capabilities
Team Lead
(Charge
RN)
Managers &
Supervisors
Directors
COO
CEO
Staff
Tiering Communication
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Journey from Reaction to Optimization
• Transition from hyrbrid system to system wide electronic system
• Grew from a department of 5 to a department of 33
• Electronic record development was based on issue management and
tickets
• Partnered with Rogers Improvement System to implement MDI
Our Story
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Deciding What to Measure
• Project decisions are made based
on potential to have influence on
strategic anchors
– Clinical Effectiveness
– Patient Experience
– Healthy Culture
– Responsible Growth
– Outreach
• Metrics were chosen based on
the impact projects would have on
these actions
Deciding How Often to Measure
• Daily
– Functional teams huddle daily to
prioritize daily tasks
• Bi-Weekly huddles
– Leadership council meets weekly
to review project risks and barriers
• Monthly
– Leadership reviews progress with
executive team to determine
needs
MDI in the Technology World
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• Leadership Council
– Staff nominated by leadership
– Empowered to own meeting and own metrics
– Subcommittees
• User Experience
• Policy and Compliance
• Finance
• Culture
• Scorecard is reviewed and decisions are made
based on problematic areas
Empowering Employees
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Before
• Electronic Health Record compliance 82%
• Solutions Compliance 71.10%
• Medication barcode scanning rate 88%
• Service Level Agreement Violations 7.14%
• Time in Medical Record 17 min per patient
• Nursing time in medical record 5 min per
patient
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• Electronic Health Record compliance increased from 82% to 91%
• Medication barcode scanning rate increased from an average of
88% to 95%
• Service Level Agreement violations decreased to 2.3%
• Time in the EMAR per patient for staff decreased from 17.45 to
15.81 minutes
– Nursing Partial Hospitalization and Intensive Outpatient level
of care time per patient hit targets for the last three months
due to a targeted implementation
Outcomes Achieved
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• Ensuring data accuracy – regain confidence from end users in
data
• Finding the right data for the right problem – finding the best
strategic match
• Scheduling and attending the daily huddles – adding value to
meetings
• Don’t let progress get in the way of perfection – start meeting
instead of waiting for the perfect set up
Challenges and Barriers
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• Align metrics selected by strategic initiatives. There are so
many metrics to pick from, using the relationship to the vision of
your organization will have more of an impact on your objectives
• Set a time limit for daily check ins. Everyone is already busy,
and it becomes too easy to get into the weeds
• Leadership should remove barriers identified in huddles right
away to maintain focus
• Transfer responsibility of reporting to employees to encourage
engagement and ownership
• Tiered reviews - We can target users daily to impact those who
are struggling while making system improvements to enhance
overall use
Recommendations
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• Initial Phases
– Position based
huddles
– Changes driven by
end user feedback
– Leadership council
• Phase 2 (in progress)
– Workstream huddles
– Creation of user councils
– Partnership with clinical
and revenue leadership
– Continued leadership
council (representation
each workstream)
– Formal training next week
Next Steps
